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Gutman CK, Koyama A, Pickett M, Holmstrom S, Ahmad FA, Hoch A, Lehto E, Schneider K, Stukus KS, Weber E, Stich C, Chernick LS. Pediatric Emergency Physicians' Knowledge, Attitudes, and Behaviors Regarding Confidential Adolescent Care. Pediatr Emerg Care 2024; 40:e94-e104. [PMID: 38355126 DOI: 10.1097/pec.0000000000003130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
OBJECTIVES More than 19 million adolescents seek care in the emergency department (ED) annually. We aimed to describe the knowledge, attitudes, and behaviors related to confidential adolescent care among pediatric ED physicians. METHODS We conducted a cross-sectional questionnaire of US physician members of the Pediatric Emergency Medicine Collaborative Research Committee survey listserv. The 24-item questionnaire assessed familiarity with adolescent confidentiality laws, attitudes toward providing confidential care, frequency of discussing behavioral health topics confidentially, and factors influencing the decision to provide confidential care. We dichotomized Likert responses and used χ 2 to compare subgroups. RESULTS Of 476 eligible physicians, 151 (32%) participated. Most (91. 4%) had completed pediatric emergency medicine fellowship. More participants reported familiarity with all sexual health-related laws compared with all mental health-related laws (64% vs 49%, P < 0.001). The median age at which participants thought it was important to begin routinely providing confidential care was 12 years; 9% thought confidential interviews should not be routinely conducted until older adolescence or at all. Their decision to provide confidential care was influenced by the following: chief complaint (97%), time (43%), language (24%), presence of family (23%) or friends (14%), and space (22%). CONCLUSIONS Respondents reported moderate familiarity with adolescent confidentiality laws. Although they viewed confidential care as something they were comfortable providing, the likelihood of doing so varied. Barriers to confidential care were influenced by their assessment of adolescents' behavioral health risk, which may contribute to health inequity. Future efforts are needed to develop strategies that augment confidential ED care for adolescents.
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Affiliation(s)
| | - Atsuko Koyama
- Department of Child Health, University of Arizona, College of Medicine, Phoenix, AZ
| | - Michelle Pickett
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | | | - Fahd A Ahmad
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Ariel Hoch
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Boston University School of Medicine, Boston, MA
| | - Elizabeth Lehto
- Department of Pediatric Emergency Medicine, Norton Children's and University of Louisville School of Medicine, Louisville, KY
| | - Kari Schneider
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Kristin S Stukus
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH
| | - Emily Weber
- Division of Pediatrics, Department of Emergency Medicine, SUNY Downstate Medical Center/Kings County Hospital Center, Brooklyn, NY
| | - Cassandra Stich
- Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, FL
| | - Lauren S Chernick
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY
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Clark JR. Coming of Age: Legal and Ethical Considerations When Caring for an Emancipated Minor. Air Med J 2024; 43:202-204. [PMID: 38821697 DOI: 10.1016/j.amj.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 06/02/2024]
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Swedler J, Alderman EM. Special Issues in Adolescent Medicine: Medical and Legal Aspects of Care in Adolescent Medicine. Clin Obstet Gynecol 2023; 66:298-311. [PMID: 37204177 DOI: 10.1097/grf.0000000000000773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Providing medical care and managing the health care needs of adolescents can be a complex process. Knowing, which adolescents can consent to health care and the scope of services adolescents can consent to, what information can be kept confidential and from whom, under which circumstances information must be disclosed, and how to navigate parental involvement, is vital for the practice of adolescent medicine. This chapter aims to address some of these issues and assist health care providers in gaining knowledge and expertise in the optimal delivery of care for adolescents.
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Affiliation(s)
- Jane Swedler
- NYU Long Island School of Medicine and Adolescent Medicine, NYU Langone Hospital-Long Island
| | - Elizabeth M Alderman
- Division of Adolescent Medicine, Albert Einstein College of Medicine and The Children's Hospital at Montefiore, New York
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Stettner NM, Lavelle EN, Cafferty P. Who decides? Consent for healthcare decisions of minors in the United States. Curr Opin Pediatr 2023; 35:275-280. [PMID: 36647569 DOI: 10.1097/mop.0000000000001218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to examine when parents and legal guardians have the authority to make medical decisions on behalf of the minors in their care, when the decisions of healthcare professionals may supersede those of parents and guardians, and under what conditions minors can make healthcare decisions for themselves. RECENT FINDINGS The coronavirus disease 2019 (COVID-19) pandemic has reignited discussion of who should make healthcare decisions for minors. Though serious adverse reactions to COVID-19 vaccines are rare, hesitancy toward pediatric COVID-19 vaccination is prevalent among parents in the United States. This has contributed to large numbers of minors who are not up-to-date or not fully vaccinated against severe acute respiratory syndrome coronavirus 2 infection. Surveys reveal a majority of minors in the United States are willing to receive a COVID-19 vaccine. A number of scholars have recommended allowing adolescents the ability to consent to COVID-19 vaccination without parental approval. SUMMARY Allowing adolescents with a minimum age of 15 to consent to vaccination without parental or guardian approval will more quickly enable adolescents to receive new vaccines as they become available, such as the COVID-19 bivalent vaccine.
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Wazir A, Sandokji I, Greaves M, Sawaya RD. Primary caregivers' experience with the informed consent process in the paediatric emergency department: An interview-based qualitative study. Paediatr Child Health 2021; 26:408-413. [PMID: 34777658 DOI: 10.1093/pch/pxab007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/24/2020] [Indexed: 11/12/2022] Open
Abstract
Objective This study aims to understand primary caregivers' (PCG) experience with the informed consent (IC) process. Methods We conducted in-depth interviews with PCGs of paediatric patients who underwent a procedure requiring IC in the paediatric emergency department (PED) of a tertiary care paediatric centre in the USA, between January and March 2013 and between September 2013 and January 2014. We triangulated the qualitative findings from the PCG interviews with Likert-scale responses from the PCGs and with results from surveyed physicians. Results We included 14 PCG-physician dyads. Our results show that PCGs understand the importance of the IC process. They appreciated the calm demeanor of providers, and the clarity of their wording. PCGs felt that IC can add to the stress, and that it could be made simpler and timelier. PCGs also had varying extents of retention of the information provided. Conclusion This exploratory study suggests an overall positive IC experience of the PCGs while highlighting areas for improvement including a more thorough discussion of alternatives, a better assessment of knowledge transmission and retention by the PCG, and recognition of the PCG's discomfort during decision making in a stressful environment.
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Affiliation(s)
- Adonis Wazir
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ibrahim Sandokji
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Morten Greaves
- Department of Education, Lebanese American University, Beirut, Lebanon
| | - Rasha D Sawaya
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Loeff DS, Shakhsheer BA. The ethics of informed consent and shared decision-making in pediatric surgery. Semin Pediatr Surg 2021; 30:151101. [PMID: 34635277 DOI: 10.1016/j.sempedsurg.2021.151101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Informed consent is a required feature in the practice of pediatric surgery. Surgeons cannot practice the trade without it and most of us learned to do it as part of our "apprenticeship" in surgical training. We were bystanders when the senior resident or attending spoke to the patient and family and we were silent witnesses to the signing of the document called a "consent." Intentional instruction about informed consent is rudimentary in most residencies. By the time we become surgical fellows, it is assumed that we have the requisite skill set to perform this "task" so we can get on with what we like to do best; operating. For many, it is viewed as a perfunctory step which, if done properly, will comply with hospital policies, might someday be exhibited during medical litigation, and ultimately it will occupy a tiny bit of memory in the hospital EMR system. However, this "thing" called the informed consent is much more than an item on a pre-op check list. The re-branding of the term "informed consent" into "shared decision-making" underscores the "re-evolution" that has occurred in thought and practice from the act of obtaining an individual's permission for treatment toward the process leading up to that act.1 It reflects some of our most important ethical values in healthcare and is still the source of scholarly inquiry and controversy. In this paper, the terms "informed consent" and "shared decision-making" will be used interchangeably but the intention is focused on the process of how physicians and their patients make choices together. If you have not thought about this topic recently, I encourage you to take a moment and explore some of the interesting and challenging questions which are still unanswered. Although the ethical principles underlying informed consent are shared by adult and pediatric medicine, there are many aspects which are unique to the medical care of children. This article highlights some of those challenges and controversies illustrated by two case studies and viewed through the lens of bioethics.
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Affiliation(s)
- Deborah S Loeff
- Section of Pediatric Surgery, Department of Surgery, UChicago Medicine, Comer Children's Hospital, Chicago, IL. and Advocate Children's Hospital, Park Ridge, IL.
| | - Baddr A Shakhsheer
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis Children's Hospital, Saint Louis, Missouri
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Curran JA, Cassidy C, Bishop A, Wozney L, Plint AC, Ritchie K, Straus SE, Wong H, Newton A, Jabbour M, MacPhee S, Breneol S, Burns E, Chorney J, Lawton J, Doyle M, MacKay R, Zemek R, Penney T, Grimshaw J. Codesigning discharge communication interventions with healthcare providers, youth and parents for emergency practice settings: EDUCATE study protocol. BMJ Open 2020; 10:e038314. [PMID: 32398342 PMCID: PMC7223275 DOI: 10.1136/bmjopen-2020-038314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Discharge communication is an important aspect of patient care but frequently has shortcomings in emergency departments (EDs). In a paediatric context, youth or parents with young children often leave the ED with minimal opportunity to ask questions or to ensure comprehension of important information. Strategies for improving discharge communication have primarily targeted patients and/or parents, although neither group has been engaged in intervention design or implementation. Furthermore, ED healthcare providers (HCPs), important actors in discharge communication practice, are rarely consulted regarding intervention design decisions. We will generate evidence to enhance discharge communication by engaging youth, parents and HCPs in the codesign of ED discharge communication strategies (EDUCATE) for asthma and minor head injury. METHODS AND ANALYSIS This mixed methods study will take place at two academic paediatric EDs in Canada. The study will occur in two phases: (A) codesign and refinement of the intervention prototypes; and (B) usability testing of the prototypes. During the first phase, two codesign teams (one for each condition) will follow a series of structured design meetings based on the Behavior Change Wheel to develop the EDUCATE interventions. Each codesign team (composed of youth, parents, HCPs and study researchers) will collaborate to identify priority target behaviours and acceptable components to include in the interventions. During the second phase, we will conduct usability testing in two EDs with a group of youth, parents and HCPs to refine the interventions. Two cycles of usability testing will be conducted with intervention refinement occurring at the end of each cycle. ETHICS AND DISSEMINATION Informed consent will be obtained from all participants. Ethics approval for this study has been obtained from the Research Ethics Board, IWK Health Centre. Results from this study will form the basis of a future effectiveness implementation trial. Key findings will be presented at national and international conferences and published within peer-reviewed journals.
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Affiliation(s)
- Janet A Curran
- Department of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Christine Cassidy
- Department of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | - Lori Wozney
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Amy C Plint
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Krista Ritchie
- Faculty of Education, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, Saint Mike's, Toronto, Ontario, Canada
| | - Helen Wong
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Amanda Newton
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Mona Jabbour
- Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Sydney Breneol
- Department of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Emma Burns
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | | | | | | | - Roger Zemek
- Department of Pediatrics, CHEO, Ottawa, Ontario, Canada
| | | | - Jeremy Grimshaw
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada
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Remick K, Gausche-Hill M, Joseph MM, Brown K, Snow SK, Wright JL, Wright J, Adirim T, Agus MS, Callahan J, Gross T, Lane N, Lee L, Mazor S, Mahajan P, Timm N, Joseph MM, Alade K, Amato C, Avarello JT, Baldwin S, Barata IA, Benjamin LS, Berg K, Brown K, Bullard-Berent J, Dietrich AM, Friesen P, Gerardi M, Heins A, Holtzman DK, Homme J, Horeczko T, Ishimine P, Lam S, Long K, Mayz K, Mehta S, Mellick L, Ojo A, Paul AZ, Pauze DR, Pearson NM, Perina D, Petrack E, Rayburn D, Rose E, Russell WS, Ruttan T, Saidinejad M, Sanders B, Simpson J, Solari P, Stoner M, Valente JH, Wall J, Wallin D, Waseem M, Whiteman PJ, Woolridge D, Young T, Foresman-Capuzzi J, Johnson R, Martin H, Milici J, Brandt C, Nelson N. Pediatric Readiness in the Emergency Department. J Emerg Nurs 2019; 45:e3-e18. [DOI: 10.1016/j.jen.2018.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Remick K, Gausche-Hill M, Joseph MM, Brown K, Snow SK, Wright JL, Adirim T, Agus MS, Callahan J, Gross T, Lane N, Lee L, Mazor S, Mahajan P, Timm N, Heiss KF, Beierle E, Besner GE, Downard CD, Fallat ME, Gow KW, Alade K, Amato C, Avarello JT, Baldwin S, Barata IA, Benjamin LS, Berg K, Bullard-Berent J, Dietrich AM, Friesen P, Gerardi M, Heins A, Holtzman DK, Homme J, Horeczko T, Ishimine P, Lam S, Long K, Mayz K, Mehta S, Mellick L, Ojo A, Paul AZ, Pauze DR, Pearson NM, Perina D, Petrack E, Rayburn D, Rose E, Russell WS, Ruttan T, Saidinejad M, Sanders B, Simpson J, Solari P, Stoner M, Valente JH, Wall J, Wallin D, Waseem M, Whiteman PJ, Woolridge D, Young T, Foresman-Capuzzi J, Johnson R, Martin H, Milici J, Brandt C, Nelson N. Pediatric Readiness in the Emergency Department. Pediatrics 2018; 142:peds.2018-2459. [PMID: 30389843 DOI: 10.1542/peds.2018-2459] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This is a revision of the previous joint Policy Statement titled "Guidelines for Care of Children in the Emergency Department." Children have unique physical and psychosocial needs that are heightened in the setting of serious or life-threatening emergencies. The majority of children who are ill and injured are brought to community hospital emergency departments (EDs) by virtue of proximity. It is therefore imperative that all EDs have the appropriate resources (medications, equipment, policies, and education) and capable staff to provide effective emergency care for children. In this Policy Statement, we outline the resources necessary for EDs to stand ready to care for children of all ages. These recommendations are consistent with the recommendations of the Institute of Medicine (now called the National Academy of Medicine) in its report "The Future of Emergency Care in the US Health System." Although resources within emergency and trauma care systems vary locally, regionally, and nationally, it is essential that ED staff, administrators, and medical directors seek to meet or exceed these recommendations to ensure that high-quality emergency care is available for all children. These updated recommendations are intended to serve as a resource for clinical and administrative leadership in EDs as they strive to improve their readiness for children of all ages.
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Affiliation(s)
- Katherine Remick
- National Emergency Medical Services for Children Innovation and Improvement Center, Baylor College of Medicine, Houston, Texas
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, Texas
- Dell Children’s Medical Center, Austin, Texas
| | - Marianne Gausche-Hill
- Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, California
- Department of Emergency Medicine and Pediatrics, David Geffen School of Medicine and Harbor–University of California, Los Angeles Medical Center, University of California, Los Angeles, Los Angeles, California
- Department of Emergency Medicine, Los Angeles Biomedical Research Institute, Los Angeles, California
| | - Madeline M. Joseph
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine and Pediatrics, University of Florida College of Medicine–Jacksonville, Jacksonville, Florida
- University of Florida Health Sciences Center–Jacksonville, Jacksonville, Florida
| | - Kathleen Brown
- Departments of Pediatrics and Emergency Medicine, School of Medicine and Health Sciences, George Washington University and Children’s National Medical Center, Washington, District of Columbia
| | | | - Joseph L. Wright
- University of Maryland Capital Region Health, University of Maryland Medical System, Cheverly, Maryland; and
- Department of Family Science, University of Maryland School of Public Health, College Park, Maryland
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Kirpekar MK, Silvay G, Augoustides JG, Castillo JG, Leong R, Sibbald R, Bainbridge D, Bishop CE, Fernando RJ, Morris B. The Adolescent Minor and Urgent Aortic Surgery: Challenges and Solutions With Capacity and Competence in Informed Consent. J Cardiothorac Vasc Anesth 2018; 33:1139-1145. [PMID: 30181083 DOI: 10.1053/j.jvca.2018.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Meera K Kirpekar
- Cardiac Anesthesiology Division, Department of Anesthesiology, The Mount Sinai Hospital, Mount Sinai Health System, New York, NY
| | - George Silvay
- Cardiac Anesthesiology Division, Department of Anesthesiology, The Mount Sinai Hospital, Mount Sinai Health System, New York, NY
| | - John G Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Javier G Castillo
- Department of Cardiovascular Surgery, The Mount Sinai Hospital, Mount Sinai Health System, New York, NY
| | - Ronald Leong
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robert Sibbald
- Department of Ethics, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Daniel Bainbridge
- Department of Anesthesiology and Perioperative Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Christine E Bishop
- Chair of the Clinical Ethics Consultation Committee, Brenner Children's Hospital, Wake Forest School of Medicine, Winston Salem, NC
| | - Rohesh J Fernando
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC
| | - Ben Morris
- Cardiothoracic and Critical Care Section, Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC
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